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Biomedical subjects

S Ahrens

Publications and source records attributed to S Ahrens.

At least 19 recordsLinked to original sources
PubMed1996

Predictors of bad and good outcome of lumbar spine surgery. A prospective clinical study with 2 years' follow up.

STUDY DESIGN: Based on prospective assessment, patients with lumbar disc surgery were examined to determine reliable predictors for clinical outcome. OBJECTIVES: The prognostic value of a screening checklist developed in a previous study was evaluated in a 2-year follow-up. SUMMARY OF BACKGROUND DATA: Outcome studies of lumbar disc surgery document a success rate between 49-90%. It has been shown that a number of medical history data and sociodemographic and psychodiagnostic findings are of prognostic value for the outcome of lumbar spine surgery. METHODS: In addition to clinical and neuroradiologic examinations, 164 patients took part in a standardized interview. Eighty-two percent participated in a follow-up performed 2 years after the operation. Preoperative findings, outcome, and prediction of three diagnostic subgroups were compared. Eighty-three (51%) patients had disc herniation only, 29 (18%) had disc herniation and other relevant back diagnoses, and 51 (31%) had no disc herniation but had other relevant back diagnoses. RESULTS: In patients with disc herniation only, good results were observed in 53%, moderate in 19%, and bad in 28%. The accuracy of prediction of the postoperative result was 75% for the patients with good outcome and 86% for those with bad outcome. In the group of patients with diagnoses other than disc herniation, the success rate of the operation was 38% good, 28% moderate, and 41% bad, but the predictor score was not as useful as for the other groups. CONCLUSION: Patients with a high risk of a bad operation outcome after lumbar discectomy could be identified preoperatively. It is suggested that those patients take part in a pain management approach instead of or in addition to surgical intervention.

Adolescent↗
PubMed1996

Self-care limitations of persons after acute myocardial infarction.

In this descriptive study, the self-care limitations of persons who had experienced their first myocardial infarction were identified during the first 3 months of their convalescent period. The five most frequently occurring limitations identified were patterns of personal and family living that interfere with self-care; intense emotional states, likes or dislikes, overriding interest and concerns; perceptions, meanings, and appraisals not in accord in reality; inability to attend to self with respect to changing conditions; and new, unrecognized requirements for self-care associated with changed health. Assessment of limitation is a framework that nurses might use to evaluate the needs of post myocardial infarction patients.

Adult↗
PubMed1996

[Surgery versus radiotherapy in Ewing's sarcoma with good prognosis. Analysis of the CESS-86 data].

PURPOSE: The evaluation of radiotherapy and surgery as exclusive local treatment in comparably selected subgroups of patients with Ewing's sarcoma on the basis of the CESS 86-data. PATIENTS AND METHODS: In the German multicenter Ewing's sarcoma study CESS 86, treatment consisted of four 9-week-courses of VACA- or VAIA-chemotherapy plus local therapy. VACA (vincristine, actinomycin D, cyclophosphamide, adriamycin) was given in low-risk extremity tumors with a tumor volume below 100 cm3. High-risk patients with central lesions or a tumor volume > 100 cm3 received VAIA (ifosfamide instead of cyclophosphamide). Local therapy started after one complete chemotherapy course in week 10. Based on an individual decision in each patient, local therapy was either radical surgery or resection plus postoperative irradiation with 45 Gy or definitive radiotherapy with 60 Gy. Because of poor results with radiotherapy in a preceding study, it was intended to restrict irradiation to patients with small lesions. RESULTS: Hundred and seventy-seven protocol patients were recruited from January 1986 through June 1991 and 176 received local therapy: 39 underwent radical surgery, 44 received definitive radiotherapy and 93 were treated with resection and postoperative irradiation. The median tumor volume was higher in patients with radiotherapy as compared to combined local treatment or radical surgery, 156 cm3 versus 140 cm3 versus 102 cm3. The overall 5-year survival after radiotherapy and surgery was nearly identical, 63% versus 67% for the whole group 75% versus 65% in tumors < 100 cm3 volume and 65% versus 67% in tumors with 100 cm3 to 600 cm3 volume, respectively. CONCLUSIONS: With regard to tumor volume, the most important single prognostic factor in Ewing's sarcoma, irradiated patients were poorer selected than surgically treated patients despite the fact that a selection of good-risk patients for radiotherapy was intended. The nearly identical survival figures after surgery and radiotherapy suggest that radiotherapy is as effective as surgery if selection of patients is comparable.

Adult↗
PubMed1996

[Inpatient psychosomatic treatment--patient markers and treatment success].

All patients who were admitted to a psychosomatic clinic during the period of one year and ended the in-patient psychotherapy regularly were evaluated before the treatment, at dismissal and one year later, the 113 (68.9%) women and 51 (31.1%) men ranged in age from 17 to 71 years, with a mean age of 39.7 years. The in-patient treatment lasted at average 9 1/2 weeks. On dismissal 85% of the patients reported a reduction of complaints. One year later 75% of the patients rated their psychological and 67% their physical state of health better compared to the time before the in-patient treatment. Standardised psychodiagnostic questionnaires (FSI, GT-S, IIP-D, SCL-90-R) demonstrated significant improvements concerning different aspects which remain stable during the follow-up period. Using the anamnestic information the prediction of treatment outcome was unsatisfactory.

Adolescent↗
PubMed1995

Predictors of bad and good outcomes of lumbar disc surgery. A prospective clinical study with recommendations for screening to avoid bad outcomes.

STUDY DESIGN: Patients were assessed by independent research teams in six different spine centers after indication for discectomy was established. Six- and twelve-month follow-ups were performed. OBJECTIVES: Objectives of this study were to determine somatic subjective symptoms, objective signs, sociodemographic, and psychological factors that influence the outcome of lumbar disc surgery, as well as to develop a screening checklist and score of reliable predictors to distinguish bad and good responders of surgery. METHODS: In addition to symptoms, signs, and neuroradiologic findings, sociodemographic data were obtained. A mobility questionnaire and Beck depression inventory were included in the structured interview. RESULTS: In all, 381 patients were examined. At 6 months 89% and at 12 months, 86% of all operated patients were available for follow-up study. There was no significant difference in the outcome between the 6- and 12-month follow-ups. Of the patients, 51.5% had a good outcome, 28.4% moderate, and 20.1% bad at 12 months follow-up. The calculation of predictor score gave an overall appropriate prediction of 80%, for good outcome 76%, and for bad 79%. CONCLUSION: In addition to clinical and radiologic examination, the Hannover Mobility Questionnaire, the Beck depression inventory, and structured interview should be included for preoperative assessment for disc surgery. If a bad outcome is predicted, it is probably more appropriate not to operate and await natural development of the disc disease or to apply conservative and psychological treatment.

Adolescent↗
PubMed1995

Coping strategies and defense mechanisms and their relevance for the recovery after discectomy.

Although several empirical studies have shown that psychological and social characteristics predict recovery after lumbar discectomy, the possible significance of the psychodynamic concept of defense mechanisms has been neglected. To investigate the predictive usefulness of defense mechanisms, coping strategies, and depression, 52 consecutive admissions were assessed before their operations and again six months later (n = 48). Using three outcome criteria, 8 patients (16, 7%) were classified as having poor operation outcomes. A stepwise discriminant analysis correctly classified 87.7% of these poor outcomes. The groups with poor and good outcome differed significantly in the prominence of two defense mechanisms: "rationalization" and "regression".

Adaptation, Psychological↗
PubMed1994

Standardized teaching plans in the ambulatory laser center.

The changing economic climate in health care has motivated nurses to clearly define their role and job duties. Ophthalmic nurses, in particular, have to relate to the differences between the skill level of nurses and technicians. Staff nurses asked to define their role in an ambulatory ophthalmic laser center, placed a high priority on patient education as a professional responsibility. Their view is supported by the Joint Commission Accreditation Manual for Hospitals, and is listed as a responsibility for the registered nurse by that agency. The Joint Commission Standards were reviewed, and a review of related theories of learning was conducted. Teaching standards were developed for nine ophthalmic laser procedures. The standards include teaching content and appropriate teaching aids. The goal is to inform patients specifically regarding the laser surgery, and eye health in general. The patient's knowledge base regarding laser surgery is addressed as part of the nursing assessment and documented in the progress note. Information regarding the proposed procedure is provided based on the teaching standard, and the patient's level of understanding is documented in the progress note. Theories of learning as well as individual teaching standards and tools will be presented.

Ambulatory Surgical Procedures↗
PubMed1991

Effect of MK-458 (HPMC) in Parkinson's disease previously untreated with dopaminergic drugs. A double-blind, placebo-controlled multicenter study.

Ninety-four patients with early Parkinson's disease were investigated in a double-blind, placebo-controlled evaluation of MK-458 [hydroxypropyl methylcellulose/lactose matrix (HPMC)], a sustained release formulation of a novel naphthoxazine compound with selective D-2 dopamine receptor agonism. Patients were previously untreated with dopaminergic drugs. Efficacy was assessed by clinical rating scales and by patient self-evaluation. MK-458 (HPMC) caused a significant decrease in most parkinsonian symptoms. Though disability rating scores were lowered by the drug, the scores did not differ significantly from placebo. However, statistically significant improvement occurred with MK-458 (HPMC) on both the physician and the patient global assessments. Adverse reactions such as nausea and vomiting, sedation, confusion, and hallucinations occurred more with MK-458 (HPMC) than with placebo. MK-458 (HPMC) possesses antiparkinsonian efficacy in early Parkinson's disease; however, side-effects are frequently associated with its use. Selective D-2 receptor agonists, such as MK-458 (HPMC), may not be the ideal treatment as monotherapy for Parkinson's disease.

Aged↗
PubMed1990

[Research activity in the psychosomatic medicine/psychotherapy specialty at West German universities--a 1978-1988 status report].

The documentation of research activities in the discipline of psychosomatics/psychotherapy at the Federal German universities during the past 10 years includes scientific papers and monographs as well as research projects. In addition, a list of theses submitted by candidates wishing to qualify for lecturing at a German university ("Habi,-litationsschrift") has been set up for the same period. The emphasis is on psychosomatic/psychotherapeutic care, specific psychosomatic diseases and the management of chronic diseases, whereas less research activity was seen in the areas of psychophysiology and epidemiology. The data represent considerable research activity in this discipline, but it would be advisable to see to it that in the future such data are better documented and coordinated.

Germany, West↗
PubMed1989

[Object related function of pain and depression].

The paper describes possible psycho-dynamic connections between the complex relations of depression and pain with regard to the classical conversion theory of Freud as well as modern narcissistic approaches. According to our clinical experience the inner organisation of pain which most regularly appears during long-term illness is formed in compliance with the pattern of an "inner object choice". The pain thus is functioning as a personalized, imaginary internal object. Such an "internal structuring" has a depression reducing quality. An empiric pilot study on 37 patients with chronical though only partly proved body pain reveals that the psychic organisation of pain as an inner object is joined with significantly lower depression scored according to Beck-Depression-Inventory (BDI). Simultaneously the infirmity period is prolonged considerably. The consequences of these findings for the practical psychotherapeutic work will have to be discussed.

Adult↗
PubMed1987

[Alexithymia without end? Attempt at a summary].

The explanations for psychosomatic illnesses derived from the concept of "alexithymia" are compared and critically analyzed within the framework of their scientific development. In an attempt to define an independent psychosomatic personality structure different from the neurotic or psychotic personality structure, Ruesch formulated the concept of the "infantile personality" in 1984. During the 1960's and independent of American authors, a French group defined as alexithymic certain characteristics of a psychosomatic personality, the central aspect of which is an affective disorder. This direction in research is then analyzed from the point of view of the limits it sets and the further perspectives it opens up.

Affective Symptoms↗
PubMed1987

Gastric irritation of oxaprozin, a new nonsteroidal, antiinflammatory drug, in comparison to acetylsalicylic acid and indomethacin: a gastric potential difference analysis.

For the evaluation of gastric irritation of oxaprozin in comparison to indomethacin and acetylsalicylic acid, a study was carried out with eight healthy male volunteers, investigating doses of 600 and 1200 mg of oxaprozin compared to therapeutical equivalents of 50 mg indomethacin and 1000 mg acetylsalicylic acid. Gastric irritation was checked with the model of the transmural gastric potential difference. The model is based on the assumption that a change in electric tension caused by a lesion of the gastric mucosa, which leads to an increasing permeability of the cell membrane for electrolytes, is a sensitive parameter for cell disintegrity. The results of the study show that oxaprozin has less irritative potency than indomethacin and can thus be qualified as an antiinflammatory drug with a minimum of gastric irritation.

Adult↗